The Child Neurology Foundation (CNF) is launching a pilot program to give 100 families with at least one child living with a neurologic condition a new Chromebook and a hotspot with 23GB of data monthly for one year. This application is to collect information about families who need this resource and make final selections. More detail is listed below:
  • CNF will select 50 families in Minnesota and 50 families in Kentucky for this program.
  • The Chromebooks and hotspots will be owned by the family once they receive it.
  • Once 100 eligible families have applied, the application will close. If more than 100 families apply, selections will begin based on need related to income and household information and families will be notified of selection by June 11th.
  • Resources are anticipated to be sent out by the end of June to families and CNF staff will be in regular contact via preferred contact method to provide assistance.
For questions please reach out to Katie Hentges at khentges@childneurologyfoundation.org.

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* 1. Are you a parent or caregiver of a child living with a neurologic condition? (includes any condition on the Child Neurology Foundation Disorder Directory)

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* 2. First Name

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* 3. Last Name

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* 4. Email Address (If you do not have an email address write "No email" in the text box)

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* 5. Phone Number

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* 6. List your street address (Note this address will be used for shipment if you are selected to receive the resources)

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* 7. List your city:

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* 8. What state do you live in?

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* 9. What is your zipcode?

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* 10. How would you prefer to communicate with CNF? (Select all that apply)

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* 11. What language do you mainly speak at home?

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* 12. What is your race? (Please select all that apply)

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* 13. What is the total number of people in your home?

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* 14. What is the total number of children in your home?

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* 15. What is your estimated household yearly income?

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* 16. What is your employment status?

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* 17. What neurologic condition does your child have? (select all that apply)

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* 18. What is the age of your child living with a neurologic condition?

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* 19. How many medical professionals does your child see per month? (Best guess is fine)

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* 20. Select the option below that best applied to how easy it is for you to use telehealth for your child's care.

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* 21. What would your family use the Chromebook and hotspot to do? (Select all that apply)

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* 22. How do you currently access the internet? (select all that apply)

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* 23. How did you hear about this opportunity?

Disclaimer

The results from this application will be used by CNF to select 100 families in Minnesota and Kentucky to receive a brand new Chromebook and hotspot with 12 months of data to access the internet. Information will be used to assess the impact of the program over time and improve services. You will receive regular contact from CNF staff to better understand how we can help your family. Contact details will never be shared outside of CNF. By submitting this application you are agreeing for CNF to use this information to improve programming.

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